TX
Texas House Bill HB139

Texas 2025 - 89th Regular

Texas House Bill HB139 Compare Versions

OldNewDifferences
1-89R21810 SCR-F
2- By: Dean, Harless, Hull, Gerdes, Tepper, H.B. No. 139
3- et al.
4- Substitute the following for H.B. No. 139:
5- By: Dean C.S.H.B. No. 139
1+89R5875 SCR-F
2+ By: Dean H.B. No. 139
63
74
85
96
107 A BILL TO BE ENTITLED
118 AN ACT
129 relating to employer health benefit plans that do not include
1310 state-mandated health benefits.
1411 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
15- SECTION 1. Section 1251.202, Insurance Code, is amended to
16- read as follows:
17- Sec. 1251.202. NOTICE REGARDING CERTAIN EMPLOYER HEALTH
18- BENEFIT PLANS. (a) In this section:
19- (1) "Employer choice of benefits plan" means a plan
20- offered under Chapter 1506.
21- (2) [,] "Standard [standard] health benefit plan"
22- means a plan offered under Chapter 1507.
23- (b) If an employer offers to employees an employer choice of
24- benefits plan or a standard health benefit plan, the employer
25- shall:
26- (1) provide a copy of the disclosure statement
27- provided to the employer by the plan issuer under Section 1506.102,
28- 1507.006, or 1507.056, as applicable, to:
29- (A) each employee:
30- (i) before the employee initially enrolls
31- in the plan, unless the employee received notice under Paragraph
32- (B) on or after the 90th day before the date the employee initially
33- enrolls; and
34- (ii) not later than the 30th day before the
35- date the employee renews enrollment in the plan; and
36- (B) each prospective employee before the
37- prospective employee is hired by the employer; and
38- (2) obtain a copy of the notice signed by the employee
39- or prospective employee at the time the notice is provided.
40- SECTION 2. Section 1275.002, Insurance Code, is amended to
41- read as follows:
42- Sec. 1275.002. APPLICABILITY OF CHAPTER. This chapter
43- applies only to:
44- (1) a health benefit plan offered by a nonprofit
45- agricultural organization under Chapter 1682; [and]
46- (2) a health benefit plan:
47- (A) that is a self-insured or self-funded plan
48- established by an employer for the benefit of the employer's
49- employees in accordance with the Employee Retirement Income
50- Security Act of 1974 (29 U.S.C. Section 1001 et seq.); and
51- (B) for which the plan sponsor has made an
52- election, submitted to the commissioner in the form and manner
53- prescribed by the commissioner, to apply this chapter to the plan
54- for the relevant plan year; and
55- (3) an employer choice of benefits plan offered under
56- Chapter 1506.
57- SECTION 3. Section 1501.002(15), Insurance Code, is amended
58- to read as follows:
59- (15) "Small employer health benefit plan" means a
60- health benefit plan developed by the commissioner under Subchapter
61- F [or any other health benefit plan offered to a small employer in
62- accordance with Section 1501.252(c) or 1501.255].
63- SECTION 4. Section 1501.213(b), Insurance Code, is amended
64- to read as follows:
65- (b) A health maintenance organization that participates in
66- a purchasing cooperative that provides employees of small employers
67- a choice of health benefit plans may use rating methods in
68- accordance with this subchapter that are used by other small
69- employer health benefit plan issuers participating in the same
70- cooperative, including rating by age and gender, if the health
71- maintenance organization has established[:
72- [(1)] a separate class of business, as provided by
73- Section 1501.202[; and
74- [(2) a separate line of business, as provided under
75- Section 1501.255(b)].
76- SECTION 5. Subtitle G, Title 8, Insurance Code, is amended
12+ SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
7713 by adding Chapter 1506 to read as follows:
7814 CHAPTER 1506. EMPLOYER CHOICE OF BENEFITS PLANS
7915 SUBCHAPTER A. GENERAL PROVISIONS
8016 Sec. 1506.001. DEFINITIONS. In this chapter:
8117 (1) "Employer choice of benefits plan" means a group
8218 health benefit plan offered to an employer that, wholly or partly,
8319 does not offer or provide state-mandated health benefits, but that
8420 provides creditable coverage as defined by Section 1205.004(a) or
8521 1501.102(a).
8622 (2) "Health benefit plan issuer" means any entity
8723 authorized under this code or another insurance law of this state to
8824 provide health insurance or health benefits in this state. The term
89- includes an insurance company and a health maintenance organization
90- operating under Chapter 843.
25+ includes an insurance company, a group hospital service corporation
26+ operating under Chapter 842, a health maintenance organization
27+ operating under Chapter 843, and a stipulated premium company
28+ operating under Chapter 844.
9129 (3) "State-mandated health benefits" means coverage
9230 or another feature required under this code or other laws of this
9331 state to be provided in a group health benefit plan that:
9432 (A) includes coverage for specific health care
9533 services or benefits;
9634 (B) places limitations or restrictions on
9735 deductibles, coinsurance, copayments, or any annual or lifetime
9836 maximum benefit amounts, including limitations provided by
9937 commissioner rule;
10038 (C) includes a specific category of licensed
10139 health care practitioner from whom an enrollee is entitled to
10240 receive care;
10341 (D) requires standard provisions or rights that
10442 are unrelated to a specific health illness, injury, or condition of
105- an enrollee;
106- (E) requires the health benefit plan to provide
107- coverage for health care services or benefits in excess of federal
108- requirements; or
109- (F) is a requirement for which an exemption is
110- provided under Section 1506.105.
43+ an enrollee; or
44+ (E) requires the health benefit plan to exceed
45+ federal requirements.
11146 Sec. 1506.002. RULES. The commissioner shall adopt rules
11247 necessary to implement this chapter.
11348 SUBCHAPTER B. EMPLOYER CHOICE OF BENEFITS PLANS
11449 Sec. 1506.101. PLANS AUTHORIZED. (a) A health benefit plan
11550 issuer may offer one or more employer choice of benefits plans.
11651 (b) An employer choice of benefits plan must include
117- coverage for an essential health benefits package as determined by
118- the commissioner based on 42 U.S.C. Section 18022, including:
119- (1) ambulatory patient services;
120- (2) emergency services;
121- (3) hospitalization;
122- (4) maternity and newborn care;
123- (5) mental health and substance use disorder services,
124- including behavioral health treatment;
125- (6) prescription drugs;
126- (7) rehabilitative and habilitative services and
127- devices;
128- (8) laboratory services;
129- (9) preventative and wellness services and chronic
130- disease management; and
131- (10) pediatric services, including oral and vision
132- care.
133- (c) An employer choice of benefits plan may not include a
134- preexisting condition exclusion.
52+ coverage for essential health benefits as defined by 42 C.F.R.
53+ Section 440.347.
13554 Sec. 1506.102. NOTICE TO ENROLLEES. (a) Each written
13655 application to enroll in an employer choice of benefits plan must
13756 contain the following language at the beginning of the document in
13857 bold type:
13958 "You have the option to enroll in this Employer Choice
140- of Benefits Plan that does not provide all coverage or features
141- normally required in health benefit plans in Texas. This employer
142- health benefit plan may provide a more affordable health benefit
143- plan for you, although, at the same time, it may provide you with
144- fewer health benefits or other features than those normally
145- included in health benefit plans in Texas. If you choose this
146- employer health benefit plan, please consult with your plan issuer
147- to discover which state-mandated health benefits or other features
148- are excluded from this health benefit plan."
59+ of Benefits Plan that, either wholly or partly, does not provide
60+ state-mandated health benefits normally required in health benefit
61+ plans in Texas. This employer health benefit plan may provide a
62+ more affordable health benefit plan for you, although, at the same
63+ time, it may provide you with fewer health benefits than those
64+ normally included as state-mandated health benefits in health
65+ benefit plans in Texas. If you choose this employer health benefit
66+ plan, please consult with your insurance agent to discover which
67+ state-mandated health benefits are excluded from this health
68+ benefit plan."
14969 (b) Each employer choice of benefits plan must contain the
15070 following language at the beginning of the document in bold type:
151- "This Employer Choice of Benefits Plan does not provide
152- all coverage or features normally required in health benefit plans
153- in Texas. This employer health benefit plan may provide a more
154- affordable health benefit plan for you, although, at the same time,
155- it may provide you with fewer health benefits or other features than
156- those normally included in health benefit plans in Texas. Please
157- consult with your employer representative to discover which
158- state-mandated health benefits or other features are excluded from
159- this health benefit plan."
71+ "This Employer Choice of Benefits Plan, either wholly
72+ or partly, does not provide state-mandated health benefits normally
73+ required in health benefit plans in Texas. This employer health
74+ benefit plan may provide a more affordable health benefit plan for
75+ you, although, at the same time, it may provide you with fewer
76+ health benefits than those normally included as state-mandated
77+ health benefits in health benefit plans in Texas. Please consult
78+ with your insurance agent to discover which state-mandated health
79+ benefits are excluded from this health benefit plan."
16080 Sec. 1506.103. DISCLOSURE STATEMENT. (a) Before a health
16181 benefit plan issuer may contract to provide an employer choice of
16282 benefits plan to an employer, the issuer must provide the employer
16383 with a written disclosure statement that:
16484 (1) acknowledges that the employer health benefit plan
16585 being contracted for does not provide some or all state-mandated
16686 health benefits; and
16787 (2) lists those state-mandated health benefits not
16888 included in the plan.
169- (b) An employer entering into a contract for an employer
170- choice of benefits plan must sign the disclosure statement provided
171- by the health benefit plan issuer under Subsection (a) and return
172- the statement to the issuer.
89+ (b) An employer entering into an initial contract for an
90+ employer choice of benefits plan must sign the disclosure statement
91+ provided by the health benefit plan issuer under Subsection (a) and
92+ return the statement to the issuer.
17393 (c) A health benefit plan issuer shall:
17494 (1) retain the signed disclosure statement in the
17595 health benefit plan issuer's records; and
17696 (2) on request from the commissioner, provide the
17797 signed disclosure statement to the department.
17898 Sec. 1506.104. ADDITIONAL HEALTH BENEFIT PLANS. A health
17999 benefit plan issuer that offers one or more employer choice of
180100 benefits plans must also offer employers at least one group health
181101 benefit plan that provides state-mandated health benefits and is
182102 otherwise authorized by this code.
183- Sec. 1506.105. COVERAGE EXEMPT FROM INSURANCE LAW. (a)
184- Except as provided by Subsection (b), an employer choice of
185- benefits plan provided under this chapter is exempt from any other
186- insurance law that does not expressly apply to the plan or this
187- chapter.
188- (b) An employer choice of benefits plan is not exempt from
189- the requirements imposed by the following:
190- (1) Titles 2, 3, 4, 5, 6, 9, and 13, as applicable,
191- except that an employer choice of benefits plan offered by a health
192- maintenance organization is exempt from requirements imposed by
193- Chapter 843 to the extent that those requirements conflict with
194- this chapter;
195- (2) Subchapters B, C, and F, Chapter 1271; and
196- (3) Sections 843.209, 1301.1581, 1301.162, and
197- 1369.153.
198- SECTION 6. The following provisions of the Insurance Code
199- are repealed:
200- (1) Section 1501.213(a);
201- (2) Section 1501.252;
202- (3) Section 1501.254;
203- (4) Section 1501.255; and
204- (5) Section 1501.259.
205- SECTION 7. This Act takes effect immediately if it receives
103+ Sec. 1506.105. COVERAGE EXEMPT FROM INSURANCE LAW. An
104+ employer choice of benefits plan provided under this chapter is
105+ exempt from any other insurance law, including common law, that
106+ does not expressly apply to the plan or this chapter.
107+ SECTION 2. This Act takes effect immediately if it receives
206108 a vote of two-thirds of all the members elected to each house, as
207109 provided by Section 39, Article III, Texas Constitution. If this
208110 Act does not receive the vote necessary for immediate effect, this
209111 Act takes effect September 1, 2025.